Reshaped CMS ACO Reach Model Aims to Deliver Better Healthcare
In a groundbreaking move, the healthcare world has revealed a transformative initiative: the CMS ACO Reach Model. As of January 1, 2023, the GPDC Model undergoes a metamorphosis, emerging as the current model. This transition, set to span four performance years until PY 2026, signifies CMS’s commitment to enhancing the quality of care for Medicare beneficiaries through improved care coordination.
The Vision of CMS ACO Reach Model
Under visionary leadership, the ACO Reach aspires to create a health system prioritizing equitable outcomes through high-quality, whole-person care. The model specifically targets Medicaid-only and dual-eligible beneficiaries, addressing health equity and bolstering access to quality care in underserved communities.
Addressing Criticisms: Why the Change?
The transition from GPDC to ACO Reach was prompted by concerns raised by members of Congress. Allegations of the privatization of Medicare and threats to quality healthcare accessibility emerged as investor-owned entities took control of Direct Contracting Enterprises (DCEs). In response, the CMS Administrator reaffirmed the commitment to value-based care, emphasizing a focus on improving healthcare experiences for diverse coverage populations.
Disclosing the Changes
Governance and Transparency: A Paradigm Shift
In contrast to the GPDC, this model introduces enhanced transparency and governance. Under the new model, providers must hold 75% of the governing board voting rights, a significant increase from the previous 25%. Beneficiary representatives and consumer advocates must now be distinct individuals with voting rights, ensuring a more robust and inclusive decision-making process.
Monitoring for Improved Accountability
This presents comprehensive monitoring and compliance requirements. Annual assessments, analysis of risk scores, and monitoring of anti-competitive actions aim to ensure accountability and identify potential issues promptly. Annual audits of contracts with providers and investigating complaints further demonstrate a commitment to transparency and quality assurance.
Closing the Health Equity Gap
Further, it addresses the health equity gap by increasing benchmarks for ACOs serving a higher proportion of underserved beneficiaries. This change aims to reduce health disparities, particularly for dual-eligible individuals, who often face worse health outcomes and reduced access to quality care. The model’s risk adjustment benchmarks based on dual eligibility status provide a more accurate reflection of costs and support closing the health equity gap.
Financial Implications: Supporting Organizations
One challenge value-based care faces is the need for upfront capital. The CMS ACO Reach Model “health equity benchmark” addresses this by providing an additional $30 per beneficiary per month for serving underserved populations. This financial support aims to enable organizations to build and redesign care delivery systems, reducing health disparities for high-needs populations.